Postural orthostatic tachycardia syndrome (POTS) can cause a number of different symptoms when you move from a seated to a standing position. These symptoms often include dizziness and fatigue.
With POTS, your autonomic nervous system has trouble keeping your bodily functions stable when you sit or stand up. This can lead to issues such as a rapid heart rate (tachycardia) or shortness of breath when you change positions.
Anyone can develop POTS, but the condition most commonly affects
POTS can involve many different combinations of symptoms. Below, you’ll find a basic guide to these symptoms, plus a few tips for getting relief.
Many POTS symptoms flare up when you change position — when you stand up, for instance, or sit up after lying down.
But certain symptoms, such as fatigue, may also persist regardless of any changes in your position.
Because POTS affects systems across your body, you may experience many different symptoms.
|cardiovascular||rapid heart rate, chest pain, dizziness, blood pooling in legs|
|respiratory||hyperventilation, bronchial asthma|
|musculoskeletal||muscle pain, muscle weakness|
|skin||rashes, flushing, excessive sweating|
|nervous||migraine, tunnel vision, tremors, brain fog, difficulty concentrating, sleep disorders|
|gastrointestinal||nausea, diarrhea, constipation, weight loss|
|urogenital||excessive urination, frequent urination at night|
POTS impacts each person differently. You may have most of these symptoms or only a few.
Often, these symptoms become severe enough to affect daily life.
According to one
- 72.4% of participants needed some type of job modifications, such as reduced hours, due to their symptoms
- 52% of participants were unemployed in the 3 months before the survey
- 20.9% of participants had lost a job due to POTS
- 66.8% of participants would work more, if not for POTS-related limitations
Experts recognize three main
- Neuropathic: Nerve fibers in your legs and abdomen have trouble carrying blood up from your legs. This can cause your legs to swell and become discolored. You may develop gastrointestinal issues due to a lack of blood flow to certain organs.
- Hypovolemic: You have less blood in your circulation system, which means less plasma and fewer red blood cells. You may notice muscle weakness and difficulty exercising.
- Hyperadrenergic: Standing up causes a spike in blood pressure and norepinephrine levels. As a result, you may feel anxious or experience headaches, tremors, nausea, dizziness, and shortness of breath.
These subtypes may overlap, so you may experience a mix of symptoms from each of the three types.
POTS symptoms may temporarily worsen due to:
Even mild physical activity, such as prolonged standing or climbing stairs, may leave you feeling exhausted, dizzy, or sore.
Mental exertion, which can happen when you do things that require a lot of brainpower, can trigger confusion, brain fog, or difficulty concentrating.
Hot environments force your body to work harder to regulate its core temperature and blood flow. Thus, people with autonomic conditions such as POTS tend to fare worse during warmer months.
The start of your circadian rhythm
You may find your symptoms are worst in the morning, as a result of lying flat for several hours without taking in any fluid.
Your body needs time to adjust to the demands of being awake, which could explain why POTS symptoms often improve as the day goes on.
If you menstruate, POTS symptoms tend to worsen right before your period, when estrogen and progesterone levels are both low.
Experts don’t yet know exactly how hormone levels influence POTS, though.
Experts have yet to determine the root cause of POTS.
Examples of triggers and health conditions that may contribute to the development of POTS include:
- Autoimmune diseases: Examples include lupus, multiple sclerosis, and Sjogren’s disease.
- Bacterial and viral infections: Examples include mononucleosis, Lyme disease, and coronavirus (COVID-19). Viral infections may trigger
between 20% and 50%of POTS cases.
- Health complications: POTS may develop after pregnancy or surgery.
- Genetic disorders: Examples include some forms of amyloidosis and Ehlers-Danlos syndrome.
- Mast cell activation diseases: Examples include mast cell activation syndrome and systemic mastocytosis.
- Toxins: Examples include heavy metals, chemotherapy, or long-term heavy drinking.
POTS and COVID-19
Pre-pandemic data suggests that between one and three million people in the United States had POTS before 2020.
Mild COVID-19 may also contribute to POTS. Even low-level cases of COVID-19 can damage your heart, lungs, brain, and other organs, causing symptoms such as tachycardia and brain fog.
A primary care doctor can diagnose POTS with a tilt-table test.
You’ll lie down on a table for at least 10 minutes to establish your baseline heart rate and blood pressure. Then your doctor will measure these vitals during a 10-minute period of being upright.
A POTS diagnosis requires you to meet the following criteria upon going upright:
- Your heart rate needs to increase by 30 beats per minute (bpm) or more from your baseline, or exceed 120 bpm.
- Your systolic blood pressure can’t decrease by more than 20 mm Hg, and your diastolic blood pressure can’t decrease by more than 10 mm Hg. Those readings would mean you had orthostatic hypotension, a different diagnosis.
Depending on your symptoms, your care team may refer you to a neurologist or cardiologist for further testing and guidance.
There’s no cure for POTS, but many people find their symptoms improve with medication and lifestyle changes.
Your treatment plan will generally depend on your specific symptoms and needs.
Possible medications may include:
- beta blockers
Potential lifestyle changes may include:
- increasing fluid intake by 2 to 3 liters a day
- increasing salt intake by 3,000 milligrams (mg) to 10,000 mg per day
- wearing compression stockings
Your care team may also recommend exercise therapy, since an extended period of physical inactivity can cause deconditioning. This decline in muscle strength, blood volume, and heart health can worsen your symptoms — but overexertion can also cause a symptom surge that sets back your physical recovery.
In short, it’s essential to listen to your body’s needs. Some people benefit from horizontal exercises such as swimming or recumbent cycling. Others find it helpful to work their way up to upright exercises and activities.
If you’re unsure about the best type of exercise to try, your care team can offer more guidance.
POTS symptoms can affect nearly every bodily system. That said, specific symptoms — and their severity — can vary widely from person to person.
If you suspect you may have POTS, a good next step involves making an appointment with your regular doctor or another clinician to get a diagnosis.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.